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Background: Recent studies have shown that preoperative education can positively impact postoperative recovery, improving postoperative pain management and patient satisfaction. Gaps in preoperative education regarding postoperative pain and opioid use may lead to increased patient anxiety and persistent postoperative opioid use. Objectives: The objective of this narrative review was to identify, examine, and summarize the available evidence on the use and effectiveness of preoperative educational interventions with respect to postoperative outcomes. Method: The current narrative review focused on studies that assessed the impact of preoperative educational interventions on postoperative pain, opioid use, and psychological outcomes. The search strategy used concept blocks including "preoperative" AND "patient education" AND "elective surgery," limited to the English language, humans, and adults, using the MEDLINE ALL database. Studies reporting on preoperative educational interventions that included postoperative outcomes were included. Studies reporting on enhanced recovery after surgery protocols were excluded. Results: From a total of 761 retrieved articles, 721 were screened in full and 34 met criteria for inclusion. Of 12 studies that assessed the impact of preoperative educational interventions on postoperative pain, 5 reported a benefit for pain reduction. Eight studies examined postoperative opioid use, and all found a significant reduction in opioid consumption after preoperative education. Twenty-four studies reported on postoperative psychological outcomes, and 20 of these showed benefits of preoperative education, especially on postoperative anxiety. Conclusion: Preoperative patient education interventions demonstrate promise for improving postoperative outcomes. Preoperative education programs should become a prerequisite and an available resource for all patients undergoing elective surgery.
Contexte: Des études récentes ont démontré que l'éducation préopératoire peut avoir un effet positif sur la récupération postopératoire en améliorant la prise en charge de la douleur postopératoire et la satisfaction des patients. Des lacunes dans l'éducation préopératoire concernant la douleur postopératoire et l'utilisation d'opioïdes peuvent entraîner une augmentation de l'anxiété chez les patients et une utilisation persistante d'opioïdes après l'opération.Objectifs: L'objectif de cette revue narrative était de recenser, d'examiner et de résumer les données probantes disponibles sur l'utilisation et l'efficacité des interventions éducatives préopératoires en ce qui concerne les résultats postopératoires.Méthode: Cette revue narrative s'est concentrée sur des études évaluant l'effet des interventions éducatives préopératoires sur la douleur postopératoire, l'utilisation d'opioïdes et les résultats psychologiques. La stratégie de recherche a eu recours à des blocs de concepts comprenant « préopératoire ¼ ET « éducation des patients ¼ ET « chirurgie élective ¼, limités à la langue anglaise, aux humains et aux adultes, en utilisant la base de données MEDLINE ALL. Les études portant sur des interventions éducatives préopératoires qui comprenaient des résultats postopératoires ont été incluses, tandis que celles qui décrivaient une amélioration de la récupération après des interventions chirurgi ont été exclues.Résultats: Sur un total de 761 articles recensés, 721 ont été examinés en entier et 34 répondaient aux critères d'inclusion. Parmi les 12 études évaluant l'effet des interventions éducatives préopératoires sur la douleur postopératoire, cinq ont rapporté des avantages pour la diminution de la douleur. Huit études ont examiné l'utilisation d'opioïdes postopératoires, et toutes ont constaté une diminution significative de la consommation d'opioïdes suite à une éducation préopératoire. Vingt-quatre études ont rendu compte des résultats psychologiques postopératoires, et vingt d'entre elles ont démontré que l'éducation préopératoire présentait des avantages, en particulier en ce qui concerne l'anxiété postopératoire.Conclusion: Les interventions éducatives préopératoires présentent des perspectives prometteuses pour améliorer les résultats postopératoires. Les programmes d'éducation préopératoire devraient devenir une condition préalable et une ressource disponible pour tous les patients subissant une chirurgie élective.
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INTRODUCTION: It has been well described that a small but significant proportion of patients continue to use opioids months after surgical discharge. We sought to evaluate postdischarge opioid use of patients who were seen by a Transitional Pain Service compared with controls. METHODS: We conducted a retrospective cohort study using administrative data of individuals who underwent surgery in Ontario, Canada from 2014 to 2018. Matched cohort pairs were created by matching Transitional Pain Service patients to patients of other academic hospitals in Ontario who were not enrolled in a Transitional Pain Service. Segmented regression was performed to assess changes in monthly mean daily opioid dosage. RESULTS: A total of 209 Transitional Pain Service patients were matched to 209 patients who underwent surgery at other academic centers. Over the 12 months after surgery, the mean daily dose decreased by an estimated 3.53 morphine milligram equivalents (95% CI 2.67 to 4.39, p<0.001) per month for the Transitional Pain Service group, compared with a decline of only 1.05 morphine milligram equivalents (95% CI 0.43 to 1.66, p<0.001) for the controls. The difference-in-difference change in opioid use for the Transitional Pain Service group versus the control group was -2.48 morphine milligram equivalents per month (95% CI -3.54 to -1.43, p=0.003). DISCUSSION: Patients enrolled in the Transitional Pain Service were able to achieve opioid dose reduction faster than in the control cohorts. The difficulty in finding an appropriate control group for this retrospective study highlights the need for future randomized controlled trials to determine efficacy.
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AIM: In the treatment of chronic hepatitis C, pegylated interferon (PEG-IFN) and ribavirin combination therapy must be continued for an adequate duration to improve the rate of sustained virological response. We attempted to predict the time point at which serum hepatitis C virus (HCV) RNA are undetectable during combination therapy. METHODS: Patients with HCV genotype 1b were enrolled in a model preparation (n = 35) and a validation group (n = 70). All patients received PEG-IFN-α-2b/ribavirin combination therapy for at least 48 weeks, and serological samples were screened a minimum of 17 times during the therapy. Serum HCV RNA were measured by the Abbott RealTime HCV assay. Using the HCV dynamics model described by Neumann et al., we used multiple linear regression analysis to select factors that affected the undetectable time point. RESULTS: Difference in viral load between weeks 1 and 2 was the only predictive factor for the undetectable time point of serum HCV RNA (r(2) = 0.67, P < 0.0005), and we derived the following prediction equation: undetectable time point (week) = 13.495 × (viral load at day 14 [log IU/mL] - viral load at day 7 [log IU/mL]) + 25.456. The equation was applicable to the validation group. CONCLUSION: We created a formula for predicting the undetectable time point from viral load measurements early in PEG-IFN-α-2b/ribavirin combination therapy. An early response reflects sensitivity to therapy, and the estimation of an undetectable time point would be useful for determining the optimal duration of treatment for chronic hepatitis C patients.
